The USC Institute for Global Health aims to improve global health by educating future and current global health leaders, carrying out trans-disciplinary research, and assuring that the evidence collected informs policy and practice to make a difference.

From Laws and Standards to Implementation of Interventions in Global Health: Human Rights in Praxis

The USC Law & Global Health Collaboration, as part of the 2018-2019 Global(HEALTH+LAW) Series, explored sexual and reproductive health and rights: a discussion of human rights policy and action led by Rajat Khosla, Senior Human Rights Officer at the United Nations Office of the High Commissioner for Human Rights, on September 27, 2018 at USC.

Rajat Khosla works as Senior Human Rights Officer at the United Nations Office of the High Commissioner for Human Rights, where his responsibilities include managing the worldwide campaign commemorating the 70th anniversary of the Universal Declaration of Human Rights. He formerly worked as Human Rights Adviser for the Department of Reproductive Health Research at the World Health Organization. He is a lawyer by training with more than 15 years of experience and specializes in issues related to human rights and humanitarian policy, in particular, sexual and reproductive health and human rights.

Lecture

Q&A

Event Summary

Introduction

Prof. Sofia Gruskin introduced Rajat Khosla, noting that he is a real hero in particular for his efforts to promote and strengthen sexual and reproductive health rights (SRHR) across the work of so many UN agencies.

Rajat Khosla’s Lecture

Khosla begins his presentation by thanking Prof. Gruskin and the audience members before stating that he thinks of the opportunity to present this lecture both as an honor and as a formidable task. He elaborated by saying that as we are currently living in a world of alternate realities where the realities being discussed at the United Nations General Assembly (UNGA) surrounding gender, gender equality and human rights are so different from the set of claims being made at the US Senate hearing of the Judiciary Committee the same morning of the lecture to confirm or deny Justice Brett Kavanaugh’s nomination to the Supreme Court. He further pointed out to the irony of the fact that even at the UN “men in dark suits” were often discussing women’s health, while many female leading experts sat in the audience.

At this point, Khosla provided an explanation for the title of his lecture: “Human Rights in Praxis.” The global context of human rights work is changing and Khosla explained the need to ask ourselves what role human rights may play in a “post-fact,” “post-reality” world. However, he pointed out that the global context is in constant flux and has changed much already. Khosla spoke about the period after second world war when the UN was created amongst commitments to alleviate the suffering of the wounded and the sick and the commitment to‘never again’. These commitments were followed by 2 landmark events: the formation of the WHO and the establishment of Universal Declaration of Human Rights (UDHR), both in 1948. Today, we are living in a paradoxical world where both institutions are under constant attack from far-right groups, among others.

Khosla elaborated the differences between norms and realities and other aspects of the changing global context for the use of a human rights-based approach in global health. Khosla then spoke about the UN’s 17 Sustainable Developmental Goals (SDGs) and expressed his belief that none of the goals are achievable without health and human rights. While using human rights in global health work is often written off as “too vague,” he noted the proliferation of clear guidelines from WHO and others that exist and are there to be used, rather than ignored.

Khosla then began discussing the need to harmonize the commitments to and lived experience of people in relation to autonomy, agency, and choice in SRHR on an international scale.

With respect to autonomy, he explained that it is a legal right and fundamental to the sustainable development of society. Supporting personal autonomy was undertaken as a commitment by 174 countries in 1994 at the Cairo Conference on Population and Development, but the practical reality of today’s world does not reflect that. To show this, Khosla gave the example of a 13-year-old girl who had been told that if she did not agree to become the sixth wife of a 70-year-old man her father would kill her. Secondly, he expounded on the concept of agency, referring to the ability to make decisions about one’s reproductive rights without threat or coercion. Again, the importance of agency in SRHR has been committed to by many countries worldwide, but he provided examples to show the decision of if or when a women might use family planning, prenatal care, or other sexual and reproductive health resources are still often made by a husband or by financial capacity.

Moving on to the specifics of the changing global context, Khosla named “conflict, climate and contaigion” as the main contributors to be addressed. In the light of the changing global context, especially the number of displaced persons around the world–out of which half are women, girls and boys–he explained that SRHR issues are usually the last to be addressed and funded. Khosla noted that this can be particularly damaging as sexual violence is at an all time high in times of conflict and crisis. Many female refugees, as young as 13-years-old, have been known to have to engage in transactional sex as a means to survive and for safe passage, with access to contraception and care minimal to none for these children and women.

Khosla then referred to the ‘new normal’ for 135 million displaced people facing climate crisis, conflict, and disease. The ineffectiveness of the health systems in many receiving countries is also relevant. Ebola and Zika are parts of this ‘new normal’. The current systems for addressing emergent migration and crisis are nowhere ready to respond to the scale of the current and rapidly approaching crises. Khosla then shared his frustrations with topic of resilience, especially while talking about climate-related disasters. He elaborated on this by making reference to the weak health systems of countries like Sierra Leone and Yemen and what little part resilience plays when such health systems fail. The need for stronger systems to be built upon principles of human rights and put in place efficiently is key.

Continuing on national health systems which he calls “not just broken but broke,” Khosla recommends a reorientation in approach. He stressed the importance of comprehensive national plans of action which take into consideration not only traditional factors but also demography, population, law and practices, and take a rights-based approach to budgeting. He pointed towards several instances including the recent Zika outbreaks and migration of Syrians fleeing violence to illustrate moments when the absence of a sufficient plan to respond to SRHR crises have been particularly visible and problematic.

Wrapping up his talk, Khosla emphasized the importance of systematically implementing human right concepts such as the availability, accessibility, acceptability and quality of health services and the need for using rights-based approaches to create a paradigm shift. On a final note, Khosla tasked the audience with focusing on and finding the best way to improve implementation and reorient current health systems to better serve the real people living in this changing world.

Q & A

Questions were asked about topics ranging from liability of a debt-ridden country towards displaced populations coming from other countries, how one might incentivize lawmakers to carry out actions based on evidence and create rights-based national action plans, and how to provide resources towards displaced populations especially when they are just transitioning through a country and do not trust the service providers due to past and rumored abuses. Firstly, Khosla emphasized that governments can be incentivized through practical methods and we both cannot and do not have to look to altruism for an argument for action.

The USC Law and Global Health Collaboration would like to sincerely thank Rajat Khosla for his valuable insights and for contributing his time and expertise to our event.

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USC Law & Global Health Collaboration

Sponsored by the USC Provost’s Office Research Collaboration Fund, the USC Law & Global Health Collaboration advances scholarship and provides monthly lectures and public discussions at the intersection of law and global health. Professor Sofia Gruskin, director of the Institute for Global Health, leads this collaboration alongside USC Gould Professor of Law and Medicine Alexander Capron and USC Research Professor and Associate Dean of Research Charles Kaplan from the Suzanne Dworak-Peck School of Social Work.